STRUCTURAL HEART DISEASE A Systematic Review on the Efficacy and Safety of Transcatheter Device Closure of Ventricular Septal Defects (VSD) LINQI YANG, M.B.B.S., M.R.C.P.CH., 1 BEE‐ CHOO TAI, M.SC., PH.D., C.STAT., 2 LAY WAI KHIN, M.B.B.S., M.SC., 2 and SWEE CHYE QUEK, M.D., F.R.C.P.CH., F.A.C.C. 1 From the 1 Department of Paediatrics, National University Health System, National University of Singapore, Singapore; and 2 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Background: Advances in interventional techniques now allow for transcatheter treatment of some ventricular septal defects (VSD), although there remain concerns about adverse events. We performed a systematic review to look at outcomes and complications associated with transcatheter closure of VSD. Method: A PubMed search for series in English on device closure of VSD from 2003 to June 2012 was performed. We excluded small series that were included in multicenter studies and patients who had acquired VSD following myocardial infarction. The random effects model was used to obtain pooled estimates of success and complications. Results: A total of 37 publications comprising 4,406 patients with VSD (perimembranous ¼ 3,758, muscular ¼ 419, intracristal ¼ 47, doubly committed subarterial ¼ 36, multiple ¼ 16, postsurgical ¼ 123, unclassified ¼ 7) were included in this analysis. The age of patients ranged from 3 days to 84 years. The pooled estimate of successful device implantation was 96.6% (95% CI: 95.7–97.5). The most common complication is residual shunt (pooled estimated 25.5%; 95% CI: 18.9–32.1). Others included valvular defects (pooled estimate 4.9%; 95% CI: 3.4–6.4) and arrhythmias (pooled estimate 10.6%; 95% CI: 8.4–12.7). Discussion and Conclusion: Our analysis suggests that transcatheter device closure of VSD is safe and yields good results. The limitations of this study are difficulties in analyzing different devices individually, and segregating the different VSD types. Further stratification by type of VSD, age of patients, and prevention of complications is needed before this can be recommended for routine treatment. (J Interven Cardiol 2014;27:260–272) Introduction Interventional techniques in cardiac catheterization have advanced by leaps and bounds in recent years, leading to significant paradigm shifts in management, including congenital heart disease (CHD), where therapeutic implantation of devices has risen over the last 2 decades. This is in large part due to constant improvement in design, materials used, and the lower profile with which newer devices boast of. Trans- catheter closure of suitable atrial septal defects 1,2 and patent ductus arteriosus 3 is now almost first‐line in treatment of these conditions in many countries. Although the results of newer devices are encouraging, it is imperative that these devices are subject to stringent scrutiny before the fraternity accepts them as standard of care. Ventricular septal defects (VSDs) are the most common congenital cardiac malformation accounting for approximately 30% of CHD. 4 To prevent long‐term complications such as pulmonary hypertension, clo- sure of VSD beyond infancy is recommended in patients with hemodynamically significant left‐to‐right shunts (Qp:Qs > 2:1). Treatment options include surgical repair and, more recently, percutaneous device closure. However, there remains considerable uncer- tainty associated with device closure, 5,6 mainly with regards to complications, especially heart block, requiring further evaluation. While it may be neither ethical nor easy to conduct trials to establish efficacy because of small numbers, there have been numerous Disclosure statement: The authors report no financial relationships or conflicts of interest regarding the content herein. Address for reprints: Swee Chye Quek, M.D., F.R.C.P.CH., F.A.C. C., Department of Paediatrics, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Fax: þ6567797486; e‐mail: swee_chye_quek@nuhs.edu.sg © 2014, Wiley Periodicals, Inc. DOI: 10.1111/joic.12121 260 Journal of Interventional Cardiology Vol. 27, No. 3, 2014